Managing patients with multimorbidity in primary care.

Multimorbidity, commonly defined as the presence of two or more chronic medical conditionsin an individual,¹ is associated with decreased quality of life, functional decline, and increased healthcare utilisation, including emergency admissions, particularly with higher numbers of coexisting conditions.²̄⁶ The management of multimorbidity with drugsis often complex, resulting in polypharmacy with its attendant risks.⁷̄⁹ Patients with multimorbidity have a high treatment burden in terms of understanding and self managing the conditions, attending multiple appointments, and managing complex drug regimens.¹⁰ Qualitative research highlights the “endless struggle” patients experience in trying to manage their conditions well.¹¹ Psychological distress is common: in an Australian survey of 7620 patients in primary care, 23% of those with one chronic condition reported depression compared with 40% of those with five or more conditions.¹² Multimorbidity presents many challenges, which may at times seem overwhelming. This review provides evidence based practice pointsthat are feasible to implement in general practice and offers guidance for general practitioners in organising care delivery. ¹²